Preventative Healthcare

Preventive healthcare is a core function of Australian general practice. Think broadly: prevent disease, identify risk, screen where evidence supports screening, immunise, detect disease early, reduce harm and promote health across the life course.

Vaccination
- Follow the current National Immunisation Program schedule.
- Check vaccination status opportunistically and use catch-up vaccination where required.
- Remember additional vaccination for Aboriginal and Torres Strait Islander people, pregnancy and specified medical risk groups.
- Influenza: annually ≥65 years, all ATSI people ≥6 months, pregnancy and specified risk groups.
- Pneumococcal: 20V in childhood; 21V from ≥65 years, ≥25 years ATSI, or ≥18 years with specified medical risk.
- Shingrix: recommended ≥50 years; NIP-funded ≥65 years, ≥50 years ATSI and specified immunocompromise ≥18 years.
- RSV: pregnancy from 28 weeks; adults ≥75 years; ATSI ≥60 years; earlier according to medical risk.
- Mild intercurrent illness is not usually a contraindication to vaccination.
- Egg allergy is not a contraindication to influenza vaccination.
- Live vaccines are generally contraindicated in pregnancy and severe immunocompromise.
- Vaccine hesitancy: RULE – Resist, Understand, Listen, Empower.
- Anaphylaxis: IM adrenaline 1:1000, 0.01 mg/kg, maximum 0.5 mg; repeat every 5 minutes if required.
- For expanded detail: Immunisation / Vaccination
Cervical cancer screening
- HPV-based screening 25–74 years every 5 years.
- Self-collected or clinician-collected HPV sampling can be used for routine screening.
- HPV 16/18 requires further assessment.
- Non-16/18 follow-up depends on the pathway and previous results.
- HPV vaccination does not remove the need for screening.
- Pregnancy is not a reason to defer screening when due.
- For expanded detail: Screening for Cervical Cancer · Cervical Screening
Breast cancer screening
- Average risk: mammography every 2 years from 50–74 years.
- Women 40–49 and ≥75 can access BreastScreen.
- Assess family history and individual risk.
- Routine clinical breast examination is not recommended for population screening.
- New breast symptoms require investigation regardless of screening history.
- For expanded detail: Screening for Breast Cancer · Breast Cancer Risk
Colorectal cancer screening
- Average risk: FIT every 2 years from 45–74 years.
- Positive FIT → colonoscopy.
- Do not use screening FIT to investigate symptoms.
- Significant personal or family history may require colonoscopic surveillance rather than population screening.
- For expanded detail: Screening for Colorectal Cancer
Lung cancer screening
- National Lung Cancer Screening Program commenced 1 July 2025.
- Age 50–70 years.
- Current smoker or quit within previous 10 years.
- Smoking history ≥30 pack-years.
- Screening test is low-dose CT.
- Symptoms require diagnostic investigation, not screening.
- For expanded detail: Oncology · Respiratory Health
Prostate cancer screening
- Do not undertake indiscriminate population PSA screening.
- Use informed shared decision-making.
- Average risk: consider PSA 50–69 years every 2 years.
- Moderately increased familial risk: consider from 45 years.
- High familial risk: consider from 40 years.
- Elevated PSA should be repeated and assessed according to the pathway.
- DRE is not recommended as routine screening in asymptomatic average-risk men.
- For expanded detail: Screening for Prostate Cancer · Men’s Health
Skin cancer
- Routine population screening of average-risk people is not recommended.
- Identify increased risk: phenotype, UV exposure, previous skin cancer, multiple/atypical naevi, immunosuppression and family history.
- Consider opportunistic examination in people at increased risk.
- Promote sun protection and awareness of new or changing lesions.
- For expanded detail: Skin Cancer · Dermatological Presentations
Cardiovascular disease risk
- Australian CVD Risk Calculator:
  - general population 45–79 years
  - diabetes 35–79 years
  - ATSI 30–79 years
- Assess individual CVD risk factors in ATSI people from 18–29 years.
- Five-year risk:
  - low <5%
  - intermediate 5–<10%
  - high ≥10%
- Moderate–severe CKD and familial hypercholesterolaemia confer clinically determined high risk.
- Treat overall absolute cardiovascular risk rather than isolated numbers.
- For expanded detail: Screening for Cardiovascular Disease · Cardiac Check-up
Type 2 diabetes
- Adults >40 years: assess diabetes risk approximately every 3 years using AUSDRISK.
- High risk: fasting glucose or HbA1c approximately every 3 years.
- Impaired glucose metabolism: generally assess annually.
- ATSI adults ≥18 years: opportunistic and/or annual direct biochemical screening rather than AUSDRISK.
- For expanded detail: Screening for Diabetes · Diabetes
Chronic kidney disease
- Kidney Health Check = BP + eGFR + uACR.
- Important risk groups include diabetes, hypertension, cardiovascular disease, previous AKI, family history, obesity and smoking.
- Confirm abnormal uACR.
- CKD requires persistent abnormal kidney structure or function for ≥3 months.
- ATSI people require earlier and more intensive case finding.
- For expanded detail: Screening for CKD · Chronic Kidney Disease
Osteoporosis and fracture prevention
- Assess fracture risk rather than indiscriminate DXA screening.
- In people ≥50 with relevant risk factors, use FRAX.
- Major osteoporotic fracture risk ≥10% generally warrants DXA.
- Minimal-trauma fracture should trigger osteoporosis assessment.
- Assess falls risk, exercise, calcium intake, vitamin D where indicated, smoking and alcohol.
- Avoid unnecessarily frequent repeat DXA.
- For expanded detail: Screening for Osteoporosis · Osteoporosis
Lifestyle risk factors – SNAP-O
- Smoking
- Nutrition
- Alcohol
- Physical activity
- Overweight / obesity
- Also consider vaping, sedentary behaviour and sleep.
- Prevention often provides more benefit through risk-factor reduction than through screening alone.
- For expanded detail: Risk Factors · Smoking Cessation Medications · Alcohol Guidelines · Obesity
Mental health and psychosocial health
- Consider depression, anxiety, suicide risk and substance use.
- Consider eating disorders, gambling, family violence, elder abuse and bullying.
- Important opportunities include adolescence, pregnancy/postpartum, chronic illness and major life events.
- Assess immediate safety where clinically indicated.
- For expanded detail: Mental Health / Psychiatry · Depression · Anxiety
Sexual health and blood-borne viruses
- Take a sexual history according to risk and sexual practices.
- Test for chlamydia, gonorrhoea, syphilis and HIV where indicated.
- Consider hepatitis B and C testing according to risk.
- Vaccinate non-immune people against hepatitis B where indicated.
- Consider contraception, reproductive intentions, PrEP and safer-sex strategies.
- For expanded detail: Sexual Health and Gender Diversity · Sexually Transmitted Infections
Pregnancy and preconception care
- Ask about pregnancy intention.
- Folate.
- Medication review.
- Optimise chronic disease.
- Smoking, alcohol and drug cessation.
- Healthy weight.
- Review vaccination and immunity.
- Genetic/family history and relevant infectious disease screening.
- Pregnancy: influenza at any gestation, dTpa preferably 20–32 weeks, RSV from 28 weeks.
- Avoid live vaccines during pregnancy.
- For expanded detail: Pregnancy and Reproductive Health · Antenatal Care
Children and adolescents
- Immunisation.
- Growth and nutrition.
- Oral health.
- Vision and hearing.
- Development and behaviour.
- Sleep and safety.
- Mental health and psychosocial wellbeing.
- Act on developmental concern rather than waiting for spontaneous resolution.
- Use a HEEADSSS framework in adolescents where appropriate.
- For expanded detail: Child and Youth Health / Paediatrics · Child Health Checks · Adolescent History
Older people
- Falls.
- Vision and hearing.
- Cognition and mood.
- Continence.
- Nutrition.
- Polypharmacy.
- Vaccination.
- Social support and mobility.
- Osteoporosis.
- Advance care planning.
- Consider elder abuse.
- Screening should increasingly be individualised according to frailty, life expectancy, comorbidity and patient goals.
- For expanded detail: Older Persons Health / Geriatrics · Falls Prevention · Advance Care Planning
Aboriginal and Torres Strait Islander health
- Culturally safe preventive care.
- Kidney Health Check annually from 18 years.
- Direct biochemical diabetes screening from 18 years.
- Assess CVD risk factors from 18 years and calculate absolute risk from 30 years.
- Earlier/additional vaccination recommendations.
- Use the Aboriginal and Torres Strait Islander health assessment.
- Use the National Guide 4th edition.
- For expanded detail: ATSI – Screening · Aboriginal and Torres Strait Islander Health
Occupational and environmental health
- Ask about occupation when relevant to the presentation or risk.
- Consider noise, dust, chemicals, biological hazards, radiation and ergonomic risks.
- Consider occupational vaccination and infection prevention.
- Suspect occupational disease when symptoms vary between work and time away from work.
- For expanded detail: Occupational and Environmental Medicine
Health assessments and opportunistic prevention
- Use recalls, registers and electronic reminders.
- Structured health assessments identify unmet preventive needs.
- Every consultation is an opportunity for appropriate preventive care.
- Do not allow preventive tasks to overwhelm the presenting problem.
- Individualise prevention using risk, evidence, potential harms, comorbidity and patient preferences.
- For expanded detail: General Check-up · Population Health / Preventative · Screening

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